The Dax Cowart Case
As a physician, I would say that it is essential to prioritize the autonomy and dignity of the patient. It is also important to respect the patient's wishes and goals for their medical care.
If Dax expressed his wish to refuse further medical treatment and to be allowed to die, as a physician, I would first attempt to understand his reasons and provide him with support, empathy, and counseling. I would make sure that Dax understands the consequences of refusing medical treatment, including the potential risks and benefits of different options.
At the same time, I would have to ask if Dax is asking to be let alone without medical treatment or if he is asking for assisted suicidethere is a difference (Shadd & Shadd, 2019).
However, if Dax has the capacity to make his own medical decisions and insists on refusing treatment (and is not asking for euthanasia), I would respect his autonomy and honor his wishes. I do not see why a patient should be given treatment if he refuses and it goes against his wishes. It would not be appropriate to continue treating him in such a case as it would be like identifying a person with a particular mental disease and insisting that the person come in for treatment even though the individual has not requested it, sought it out, and even at that moment wants to refuse it. Holding a patient against his will in a hospital does not sound like something a health practitioner should do if the patient wants to be left alone.
That being said, as a physician, I would make sure that Dax is not making a decision under duress, or severe mental stress, and I would work to address any underlying issues that may be impacting his decision-making capacity. If Dax lacked decision-making capacity, then a surrogate decision-maker, such as a legal guardian or family member, may be involved in making medical decisions on his behalf, in accordance with his known wishes and best interests (Pace et al., 2020).
Ethical Dilemmas
There are several ethical dilemmas presented in the case of Dax Cowart. However, the most relevant ethical dilemma presented in his case are respect for patient autonomy vs. beneficence and informed consent.
Respect for Patient Autonomy versus Beneficence
The first ethical dilemma is the tension between respect for Dax Cowart's autonomy and the principle of beneficence. Dax Cowart was competent and had the capacity to make his own medical decisions. He made it clear that he did not want to receive any medical treatment, including pain relief, as he believed that the treatment was causing him more harm than good. The ethical dilemma arises when the physician, who is bound by the principle of beneficence, has to decide whether to continue with the medical treatment or respect Dax's autonomy and allow him to refuse treatment.
Informed Consent
The second ethical dilemma is the issue of informed consent. In the case of Dax Cowart, he was subjected to multiple surgeries and painful treatments against his wishes. He later described the treatment as torture. This raises the question of whether he was given adequate information about the risks and benefits of the treatment and whether his consent was truly informed. The ethical dilemma is whether the physician, who...
…skills to effectively navigate these difficult situations and minimize moral distress.The contemporary case of the patient refusing forced feedings highlights the ongoing ethical and legal debate around patient autonomy and medical decision-making (Associated Press, 2016). In this case, the judge ruled that the patient had the right to refuse forced feedings, even if it could result in her death. This decision is consistent with the ethical principle of autonomy, which recognizes the right of patients to make decisions about their own bodies, even if it leads to harm or death.
Contemporary policies, standards, and laws have been put in place to prevent similar dilemmas. The Patient Self-Determination Act requires healthcare institutions to inform patients of their right to make decisions about their medical care, including the right to refuse treatment (Mulholland, 2020). Medical professionals are also required to obtain informed consent from patients before providing medical treatment, which includes a detailed discussion of the risks, benefits, and alternatives to treatment.
What There is to be Learned
From examining this case, there is a lot to be learned about the importance of patient autonomy and the ethical principles that guide medical decision-making. The case of Dax Cowart underscores the need for healthcare providers to respect patients' rights and provide guidance and support to help patients make informed decisions about their medical care. It also highlights the importance of education and training for healthcare providers to effectively navigate ethical dilemmas and minimize moral distress. At root, however, it illustrates the importance of respecting patient wishes and not forcing care upon a patient who does not want, no matter how much good a provider might think he…
References
Associated Press. (2016). Judge: Severely anorexic patient can refuse forced feedings. Retrieved from https://www.statnews.com/2016/11/23/anorexic-forced-feedings/
Dax Cowart Speech. (n.d.). Retrieved from https://www.youtube.com/watch?v=lSsu6HkguV8
Mulholland, K. C. (2020). Protecting the Right to Die: The Patient SelfDetermination Act of1990. In Who Decides? (pp. 165-186). Routledge.
Pace, A., Koekkoek, J. A., Van Den Bent, M. J., Bulbeck, H. J., Fleming, J., Grant, R., ... &Dirven, L. (2020). Determining medical decision-making capacity in brain tumor patients: why and how?. Neuro-oncology practice, 7(6), 599-612.
Shadd, P., & Shadd, J. (2019). Institutional non?participation in assisted dying: Changing theconversation. Bioethics, 33(1), 207-214.
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